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People in general do not have a good understanding of American healthcare insurance. They might think they do but actually do not. I got my graduate degree in public health, otherwise known as preventative medicine. I had to take an entire class on the subject “healthcare finances” where we ended up discussing many different financial aspects of the healthcare system in America, hospital costs, as well as how people create these very complex webs of financial relationships in the healthcare sphere. The short version: it is extremely grueling to figure out how what affects what and who determines what cost in the healthcare hemisphere.
What it all comes down to at the end of the day, however, is money. The simplest way to describe it to others is by using a pie as a metaphor. The pie represents money. Everyone wants a piece of the pie. Who gets what portion of the pie comes down to negotiation. If someone isn’t happy with their slice of pie at the end of the day, they may choose to not partake at all in the pie and negotiate another pie altogether. This is the easiest way to explain why some doctors and medications get covered by a healthcare insurance plan (or don’t). It doesn’t matter who is offering the plan. It doesn’t matter if it’s health insurance “offered through the government”, your employer, or any other potential option for who can give you health insurance.
